Quick Tip: Vasopressors in accidental hypothermia

This blog is here to focus on frugality but I'm still a pharmacist and I had a case come in that presented a good opportunity for a post.

With the so-called polar vortex here and brining record low temperatures, it's important to consider the recommendations for vasopressor use in patients presenting with cardiac arrest secondary to accidental hypothermia (remember your H's and T's).

According to the 2015 ACLS guidelines¹

• It may be reasonable to consider administration of a vasopressor during cardiac arrest according to the standard ACLS algorithm concurrent with rewarming strategies

The 2015 ERC guidelines from the other side of the pond are a little different²

• Core temperature <30°C (86°F): withhold epinephrine
• Core temperature 30-35°C (86-95°F): intervals between drug doses should be doubled (i.e. every 6-10 minutes for epinephrine)

I'm not here to tell you which recommendation to follow, just simply summarizing the various recommendations. The discrepancy is the result of insufficient evidence either way. I personally follow the ERC guidelines as I feel it's more important to focus on high quality compressions and rewarming techniques rather than medications that can potentially cause harm. Sure I'm "just a pharmacist" but that doesn't mean I'm too good to walk to the trauma bay to pick up a set of chest tubes.

This information represents my opinion and is not intended to be used as clinical advice for patient care.

References:

1.      Lavonas EJ, Drennan IR, Gabrielli A, et al. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S501-18.

2.      Truhlář A, Deakin CD, Soar J, et al. European Resuscitation Council Guidelines for Resuscitation 2015: Section 4. Cardiac arrest in special circumstances. Resuscitation. 2015;95:148-201.